Interpretive Summary: Severe childhood malnutrition can occur with or without edema (whole body swelling). Children with edema are more likely to die. It is not known why edema occurs in some cases and not in others. To explore whether the food eaten as the child becomes malnourished might be related to the appearance of swelling, a dietary survey of severely malnouirshed Malawian children was done.
One hundred forty-five severely malnourished children with edema were surveyed and 46 children without edema. It was found that children with edema ate less egg and tomato than children without edema. Both groups of children included a similar variety of foods in their diet.
Further research should be done to determine if consumption of less egg and tomato actually causes the appearance of swelling with severe malnutrition.

Technical Abstract:
Nutritionists have suggested that kwashiorkor is related to low dietary protein and/or antioxidant intake. This study explored the hypothesis that among Malawian children with severe malnutrition, those with kwashiorkor consume a diet with less micronutrient- and antioxidant-rich foods, such as fish, eggs, tomatoes, and orange fruits (mango, pumpkin and papaya), than those with marasmus. A case-control method with a food frequency questionnaire was used to assess the habitual diet. Children with severe childhood malnutrition presenting to the central hospital in Blantyre, Malawi, during a 3-month period in 2001 were eligible to participate. The food frequency questionnaire collected data about foods consumed by siblings <60 months of age in the home. It was assumed that the habitual diet of all siblings 1-5 years old in the same home was similar. Dietary diversity was assessed using a validated method, with scores that ranged from 0 to 7. Regression modelling was used to control for demographic and disease covariates. A total of 145 children with kwashiorkor and 46 with marasmus were enrolled. Children with kwashiorkor consumed less egg and tomato than those with marasmus: 17 (15) vs. 24 (31) servings per month for egg, mean (SD), P < 0.01 and 27 (17) vs. 32 (19) servings per month for tomato, P < 0.05. Children with kwashiorkor had a similar dietary diversity score as those with marasmus, 5.06 (0.99) vs. 5.02 (1.10), mean (SD). Further research is needed to determine what role consumption of egg and tomato may play in the development of kwashiorkor.